Delayed Perirenal Hematoma after Kidney Biopsy: A Case Report

T. I Boudhaye1*, A. Janane2, A. Ameur2 and M. Abbar2

1 Department of Urology, Military Hospital of Nouakchott, Mauritania
2Department of Urology, Teaching Military Hospital of Med V, Rabat, Morocco

Corresponding author: Taher Ismail Boudhaye, Department of Urology, Military Hospital of Nouakchott, BP: 178, Nouakchott, Mauritania; E-mail:rghibe96@yahoo.fr

Recevied Date: July, 9 2016, Accepected Date: July 18, 2016, Published: July 20, 2016.

Citation: T. I Boudhaye, A. Janane, A. Ameur and M. Abbar (2016) Delayed Perirenal Hematoma after Kidney Biopsy: A Case Report. BAOJ Urol Nephrol 1: 002.

Copyright: 2016 T. I Boudhaye, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract
Percutaneous renal biopsy (PRB) is a safe and effective tool in the diagnosis and management of renal disease, complications may occur and are usually associated with bleeding. However, delayed perirenal hematoma is so rare.

We describe a 35 year old man with infected perirenal hematoma diagnosed one month following a kidney a kidney biopsy.

Keywords: Kidney; Biopsy; Hematoma

Introduction
Major bleeding following kidney biopsy is rare; appearance of a palpable hematoma has been reported in 1% of native kidney biopsy. In most cases, no surgical intervention is required. Beyond hemodynamic instability, large hematomas may be further complicated by infection, acute renal failure or hypertension [1]. We report a case of a large perirenal hematoma occurred after percutaneous needle renal biopsy causing pain and flank mass.

Case Report
A 35 year old man was admitted to our institution via emergency room with gross mass (Fig.1) and left flank pain associated with fever. He had undergone a percutaneous ultrasound-guided renal biopsy one month earlier because of nephrotic syndrome (they had used 16G automated gun needle and gotten 3 pieces of tissue).

Laboratory tests were normal except for an elevated CRP.

Abdominal computed tomography showed a 12X14cm left perirenal hematoma displacing the kidney forward (Fig 2, 3, 4).
Surgical drainage was performed via a lumbotomy. The drained liquid was taken for microbiological study, which was positive, antibiotic therapy was instituted. The outcomes were favorable, Abdominal computed tomography achieved after one month was normal (Fig.5).

Discussion
The PRB is safe and free of complications in the majority of case. In a review of 9595 biopsies performed in 50 years, only 0.3% of patients required major surgical or radiographic intervention, and death resulting from the procedure occurred in 0.1% of cases [2].

The severity of complications by PRB is usually divided into two groups. Minor complications were defined as those resulting in gross hematuria and/or perinephric hematoma but spontaneously resolving without the need of further intervention. Major complications were those resulting in the need of an intervention, such as a transfusion of blood products or invasive procedure (radiological or surgical intervention), and those resulting in acute renal obstruction or failure, septicemia, or death [3].

The common complications of percutaneous needle renal biopsy include hematuria, perinephric hematoma, arteriovenous fistula, aneurysm and infections [3].

Although clinically significant perinephric hematoma occur in 6% or fewer of biopsies, perinephric hematomas have been demonstrated at 24 to 72 hours after biopsy in 90% of cases evaluated prospectively [2,4].

The majority of hematomas are asymptomatic and small in size, but in up to 50% of biopsies, they are moderate to large in size [4,5].

Factors that have been found to predispose to complications after PRB include renal insufficiency, poorly controlled hypertension (diastolic BP; 90 to 110 mmHg), and a prolonged bleeding time [3,6]. Our case correspond to grade III-b according to Clavien-Dindo [7] grading system for the classification of surgical complications (table.1)

John et al[3] reported a case of renal pelvic hematoma occurred by delayed re-bleeding 8 days after percutaneous needle renal biopsy causing gross hematuria and hydronephrosis, treated with infusion of normal saline and furosemide to increase urine output. They also inserted a double J stent into the left ureter to reduce the hydronephrosis and maintain urine flow, in their case, the hematoma measured 2.2x2.7 cm.

Hausseman et al[1] described a patient with prolonged fever following kidney biopsy.

Workup disclosed a large perirenal and retroperitoneal hematoma, this patient was treated with antibiotics, fever eventually resolved spontaneously.

In our case, a surgical drainage was performed, because of the large volume of the hematoma and infectious syndrome associated, the infection progresses Probably from the day of the PRB, the patient had a fever at 40-41 , the abdominal computed tomography showed a large collection, for these reasons, we chose surgical drainage.

Conclusion
Delayed perirenal hematoma after kidney biopsy is rare. The surgical drainage is safe when the hematoma was large and infected although interventional radiology is effective when available.

References
Hausmann MJ, Kachko L, Basok A et al (2009) prolonged fever following kidney biopsy : a case report; International urology and nephrology. 41: 423-425.

Korbet SM (2002) percutaneous biopsy. Semin Nephrol 22(3): 254-267.

Jeon DH, Seo JW, Kang Y et al (2010) renal pelvic hematoma induced by delayed re-bleeding after renal biopsy, the Korean journal of nephrology 29: 768-771.

Whittier WL, Korbet SM (2004) Timing of Complications in percutaneous renal biopsy, J Am Soc Nephrol 15(1): 142-147.

Ginsburg JC, Fransman SL, Singer MA et al (1980) Use of computerized tomography to evaluate bleeding after renal biopsy. Nephron 26(5): 240-243.

Christensen J, Lindequist SL, Knudsen DU et al (1995) Ultrasound-guided renal biopsy with biopsy gun technique efficacy and complications. Acta Radiol 36: 276-279.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg Aug 240(2): 205-213.